- Enrollment id
- O20040920000977
- Enrollment state
- IL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1841295763
- Multiple npi flag
- N
- Ccn
- 141616
- Associate id
- 4385551258
- Organization name
- IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
- Doing business as name
- IROQUOIS MEMORIAL HOSPICE
- Incorporation date
- 1921-10-04
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 200 E FAIRMAN AVE
- City
- WATSEKA
- State
- IL
- Zip code
- 609701644